Identifying bipolar disorders in individuals with intellectual disability

Objective The aim of the present study was to characterize adults with intellectual disability (ID) and concomitant clinical diagnoses of bipolar disorder (BPD), and determine whether DSM‐IV criteria would distinguish individuals with BPD from patients with other psychiatric diagnoses. Methods A retrospective chart review was done of a convenience sample of adult patients seen over a 3‐year period in a specialty clinic for adults with ID and psychiatric disorders. The DSM‐IV criteria were used to differentiate individuals with clinical symptoms of BPD from groups of patients with other mood or thought disorders with behavioural symptoms which frequently overlap those of BPD. Behavioural symptoms were also catalogued and used to distinguish the diagnostic groups. Results Subjects with clinical symptoms of BPD had significantly more DSM‐IV mood‐related and non‐mood‐related symptoms, as well as functional impairments, compared to individuals with major depression, depression with psychosis or schizophrenia/psychosis NOS (not otherwise specified). Likewise, behavioural profiles of the BPD group of patients differed significantly from patients in the other three groups. Conclusions Bipolar disorder can be readily recognized and distinguished from other behavioural and psychiatric diagnoses in individuals with ID, and DSM‐IV criteria can be useful in the diagnosis of BPD.     

Twelve‐month prevalence,comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1‐MH)

This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1‐MH]). A nationally representative sample (N = 5318) of the adult (18–79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS‐CIDI) to assess symptoms, syndromes and diagnoses according to DSM‐IV‐TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18–34: 37% versus 20% in age group 65–79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio‐economic status (22%). High degree of urbanization (> 500,000 inhabitants versus < 20,000) was associated with elevated rates of psychotic (5.2% versus 2.5%) and mood disorders (13.9% versus 7.8%). The findings confirm that almost one third of the general population is affected by mental disorders and inform about subsets in the population who are particularly affected. Copyright © 2014 John Wiley & Sons, Ltd.     

Impact of childhood life events and trauma on the course of depressive and anxiety disorders

Hovens JGFM, Giltay EJ, Wiersma JE, Spinhoven P, Penninx BWJH, Zitman FG. Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Objective: Data on the impact of childhood life events and childhood trauma on the clinical course of depressive and anxiety disorders are limited. Method: Longitudinal data were collected from 1209 adult participants in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events and trauma at baseline were assessed with a semi‐structured interview and the clinical course after 2 years with a DSM‐IV‐based diagnostic interview and Life Chart Interview. Results: At baseline, 18.4% reported at least one childhood life event and 57.8% any childhood trauma. Childhood life events were not predictive of any measures of course trajectory. Emotional neglect, psychological and physical abuse, but not sexual abuse, were associated with persistence of both depressive and comorbid anxiety and depressive disorder at follow‐up. Emotional neglect and psychological abuse were associated with a higher occurrence of a chronic course. Poor course outcomes were mediated mainly through a higher baseline severity of depressive symptoms. Conclusion: Childhood trauma, but not childhood life events, was associated with an increased persistence of comorbidity and chronicity in adults with anxiety and/or depressive disorders. More unfavourable clinical characteristics at baseline mediate the relationship between childhood trauma and a poorer course of depressive and anxiety disorders.     

Major depression and bipolar disorders in CADASIL: a study using the DSM-IV semi-structured interview

Valenti R, Pescini F, Antonini S, Castellini G, Poggesi A, Bianchi S, Inzitari D, Pallanti S, Pantoni L. Major depression and bipolar disorders in CADASIL: a study using the DSM‐IV semi‐structured interview.
Acta Neurol Scand: 2011: 124: 390–395.
© 2011 John Wiley & Sons A/S. Objective – Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral microangiopathy characterized by migraine, cerebrovascular events, and cognitive impairment. Although recognized as a cardinal feature of the disease, psychiatric disturbances have rarely been the object of focused studies. We performed a structured evaluation of mood disorders in CADASIL. Materials and Methods – Twenty‐three patients with CADASIL (five men and 18 women) were assessed by psychiatrists using the Structured Clinical Interview for the DSM‐IV, clinician version. For the quantitative assessment of current mood disorder symptoms, the Hamilton Rating Scale for Depression (HRSD) and the Young Mania Rating Scale (YMRS) were used. Results – A lifetime depressive episode was recorded in 17/23 (73.9%) patients with CADASIL. Six (26.1%) patients with CADASIL reported a current depressive episode. A diagnosis of manic lifetime episode was made in 6 (26.1%) patients with CADASIL. The HRSD mean score in patients with current depression was 9.1 ± SD 8.1. The YMRS mean score was 14.2 ± SD 4.1 for manic CADASIL. Conclusion – This study confirms that mood disorders are frequent in CADASIL. The use of a structured psychiatric interview outlines a frequency of depression higher than that previously reported but also reveals a considerable frequency of bipolar disorders. If confirmed in larger series, these data suggest that a greater attention should be paid to the psychiatric aspects in CADASIL.     

Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal

Background: Efforts to develop and validate fully‐structured diagnostic interviews of mental disorders in non‐Western countries have been largely unsuccessful. However, the principled methods of translation, harmonization, and calibration that have been developed by cross‐national survey methodologists have never before been used to guide such development efforts. The current report presents the results of a rigorous program of research using these methods designed to modify and validate the Composite International Diagnostic Interview (CIDI) for an epidemiological survey in Nepal. Methods: A five‐step process of translation, harmonization, and calibration was used to modify the instrument. A blinded clinical reappraisal design was used to validate the instrument. Results: Preliminary interviews with local mental health expert led to a focus on major depressive episode, mania/hypomania, panic disorder, post‐traumatic stress disorder, generalized anxiety disorder, and intermittent explosive disorder. After an iterative process of multiple translations‐revisions guided by the principles developed by cross‐national survey methodologists, lifetime DSM‐IV diagnoses based on the final Nepali CIDI had excellent concordance with diagnoses based on blinded Structured Clinical Interview for DSM‐IV (SCID) clinical reappraisal interviews. Conclusions: Valid assessment of mental disorders can be achieved with fully‐structured diagnostic interviews even in low‐income non‐Western settings with rigorous implementation of replicable developmental strategies. Copyright © 2013 John Wiley & Sons, Ltd.     

Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services

OBJECTIVES: To compare the prevalence and agreement of diagnoses based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) and clinician assignment for youths receiving public mental health services between 1996 and 1997 and to examine potential predictors of diagnostic agreement. METHOD: Participants included 240 youths aged 6-18 years. Past-year prevalence rates and kappa statistics were calculated for four diagnostic categories: anxiety, mood, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBD). Potential predictors of diagnostic agreement were examined with logistic regression analysis. RESULTS: The prevalence of ADHD, DBD, and anxiety disorders was significantly higher based on the DISC-IV, while the prevalence of mood disorders was significantly higher based on clinician assignment. Diagnostic agreement was poor overall. The kappa values ranged from -0.04 for anxiety disorders to 0.22 for ADHD. Significant predictors of agreement varied by diagnosis and included symptom severity, comorbidity, youth age and gender, and school-based problem identification. CONCLUSIONS: Consistent with previous findings of poor diagnostic agreement between structured interviews and clinicians, these results call for a better understanding of factors affecting diagnostic assignment across different methods. This is especially important if researchers continue to use structured interviews to determine prevalence, establish diagnosis-based treatment guidelines, and disseminate evidence-based treatments to community mental health settings.     

Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive-compulsive disorder

Is obsessive–compulsive disorder (OCD) a discrete disorder? Three hundred thirty‐four individuals with OCD were interviewed using the Structured Clinical Interview for DSM (SCID). Results demonstrate that OCD is highly comorbid with other neuropsychiatric disorders, with 92% of OCD study participants receiving one or more additional Axis I DSM diagnoses. Among these additional diagnoses, lifetime mood disorders (81%) and anxiety disorders (53%) were the most prevalent. With the exception of substance‐related disorders and specific phobias, all disorders assessed were found in considerably higher frequency than in the general population, indicating that OCD is associated with highly complex comorbidity. These data have implications for genetic studies of OCD and disorders related to OCD, as well as for specific psychotherapeutic and psychopharmacologic interventions. Depression and Anxiety 19:163–173, 2004 Published 2004 Wiley‐Liss, Inc.     

Culture and the anxiety disorders: recommendations for DSM‐V

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM‐IV‐TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over‐specification” of disorders, the post‐DSM‐III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross‐cultural limitations in DSM‐IV‐TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity‐related factors that might limit the universal applicability of the diagnostic criteria for six anxiety disorders. Results: Possible mismatches between the DSM criteria and the local phenomenology of the disorder in specific cultural contexts were found for three anxiety disorders in particular. These involve the unexpectedness and 10‐minute crescendo criteria in Panic Disorder; the definition of social anxiety and social reference group in Social Anxiety Disorder; and the priority given to psychological symptoms of worry in Generalized Anxiety Disorder. Limited evidence was found throughout, particularly in terms of neurobiological markers, genetic risk factors, treatment response, and other DSM‐V validators that could help clarify the cross‐cultural applicability of criteria. Conclusions: On the basis of the available data, options and preliminary recommendations for DSM‐V are put forth that should be further evaluated and tested. Depression and Anxiety, 2010© 2009 Wiley‐Liss, Inc.     

A prospective latent analyses study of psychiatric comorbidity of DSM‐IV bipolar I and II disorders

Mantere O, Isometsä E, Ketokivi M, Kiviruusu O, Suominen K, Valtonen HM, Arvilommi P, Leppämäki S. A prospective latent analyses study of psychiatric comorbidity of DSM‐IV bipolar I and II disorders.
Bipolar Disord 2010: 12: 271–284. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S. Objective: To test two hypotheses of psychiatric comorbidity in bipolar disorder (BD): (i) comorbid disorders are independent of BD course, or (ii) comorbid disorders associate with mood. Methods: In the Jorvi Bipolar Study (JoBS), 191 secondary‐care outpatients and inpatients with DSM‐IV bipolar I disorder (BD‐I) or bipolar II disorder (BD‐II) were evaluated with the Structured Clinical Interview for DSM‐IV Disorders, with psychotic screen, plus symptom scales, at intake and at 6 and 18 months. Three evaluations of comorbidity were available for 144 subjects (65 BD‐I, 79 BD‐II; 76.6% of 188 living patients). Structural equation modeling (SEM) was used to examine correlations between mood symptoms and comorbidity. A latent change model (LCM) was used to examine intraindividual changes across time in depressive and anxiety symptoms. Current mood was modeled in terms of current illness phase, Beck Depression Inventory (BDI), Young Mania Rating Scale, and Hamilton Depression Rating Scale; comorbidity in terms of categorical DSM‐IV anxiety disorder diagnosis, Beck Anxiety Inventory (BAI) score, and DSM‐IV‐based scales of substance use and eating disorders. Results: In the SEM, depression and anxiety exhibited strong cross‐sectional and autoregressive correlation; high levels of depression were associated with high concurrent anxiety, both persisting over time. Substance use disorders covaried with manic symptoms (r = 0.16–0.20, p < 0.05), and eating disorders with depressive symptoms (r = 0.15–0.32, p < 0.05). In the LCM, longitudinal intraindividual improvements in BDI were associated with similar BAI improvement (r = 0.42, p < 0.001). Conclusions: Depression and anxiety covary strongly cross‐sectionally and longitudinally in BD. Substance use disorders are moderately associated with manic symptoms, and eating disorders with depressive mood.     

Self‐reported utilization of mental health services in the adult German population – evidence for unmet needs? Results of the DEGS1‐Mental Health Module (DEGS1‐MH)

This paper provides up‐to‐date data on service use for mental health problems and disorders among adults aged 18‐79 years in Germany derived from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1‐MH; N=4483). Data are based exclusively on self‐report. Respondents were examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview DIA‐X/M‐CIDI to assess diagnoses according to the criteria of DSM‐IV‐TR. Service use, i.e. contact to mental health care services, due to mental health problems was assessed for the past 12 months and lifetime, by type of sector and type of institution. Among respondents with a 12‐month diagnosis of a mental disorder, 23.5% of the women and 11.6% of the men reported any service use in the past 12 months. Service use depends on type of diagnosis, comorbidity and socio‐demographic characteristics. Lowest 12‐month utilization rates were found for substance use disorders (15.6%; lifetime use 37.3%), highest for psychotic disorders (40.5%; lifetime 72.1%). Further, a considerable time lap was found between disorder onset and subsequent service use among the majority of cases with anxiety and mood disorders. This paper provides self‐reported epidemiological data on mental health service use in Germany, complementing administrative statistics and the predecessor mental health module of the German Health Interview and Examination Survey (GHS‐MHS) from 1998. Despite considerable changes in the mental health field in Germany and the existence of a comprehensive mental health care system without major financial barriers, we find no indications of substantially higher utilization rates for mental disorders as compared to other comparable European countries. Further, no indications of major overall changes in utilization rates are apparent. To pinpoint areas with unmet needs, more detailed analyses of the data are needed taking into account type, frequency, and adequacy of service use and treatment of mental disorders. Appropriately matched comparisons with the GHS‐MHS are needed to identify changes in patterns of utilization and interventions by type of disorder. Copyright © 2014 John Wiley & Sons, Ltd.     

Social phobia in Finnish general adolescent population: prevalence,comorbidity, individual and family correlates,and service use

Background: Few studies have investigated the epidemiology of social phobia (SP) among early to middle adolescents, at the time of suggested mean onset of the disorder. The objective of this study was to investigate the prevalence, comorbidity, individual and familial correlates, and service use associated with SP among Finnish 12–17‐year‐old adolescents in general population. Methods: A sample of 784 adolescents was screened with the Social Phobia Inventory, and a sub‐sample (n=350) was interviewed with a semi‐structured clinical interview to identify SP, sub‐clinical SP (SSP), and a range of other axis I DSM‐IV disorders. Individual and familial correlates, and service use associated with SP were also inquired. Results: We found a 12‐month prevalence of 3.2% for SP, and 4.6% for SSP. The prevalence rose and the gender ratio shifted to female preponderance as age increased. SP was frequently comorbid with other anxiety disorders (41%) and depressive disorders (41%). Adolescents with SP/SSP were impaired in their academic and global functioning, and reported more parental psychiatric treatment contacts. Two thirds (68%) of adolescents with SP reported having been bullied by peers. Only one fifth of adolescents with non‐comorbid SP had been in contact with a mental health professional. Conclusions: We conclude that adolescent SP is a relatively frequent, undertreated and highly comorbid condition, associated with educational impairment, depression and anxiety in parents, and peer victimization. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Depressive and anxiety disorders in epilepsy: Do they differ in their potential to worsen common antiepileptic drug–related adverse events?

Purpose: To compare the effect of anxiety disorders, major depressive episodes (MDEs), and subsyndromic depressive episodes (SSDEs) on antiepileptic drug (AED)–related adverse events (AEs) in persons with epilepsy (PWE). Methods: The study included 188 consecutive PWE from five U.S. outpatient epilepsy clinics, all of whom underwent structured interviews (SCID) to identify current and past mood disorders and other current Axis I psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM‐IV‐TR) criteria. A diagnosis of SSDE was made in patients with total Beck Depression Inventory‐II (BDI‐II) scores >12 or the Centers of Epidemiologic Studies‐Depression (CES‐D) > 16 (in the absence of any DSM diagnosis of mood disorder. The presence and severity of AEs was measured with the Adverse Event Profile (AEP). Key Findings: Compared to asymptomatic patients (n = 103), the AEP scores of patients with SSDE (n = 26), MDE only (n = 10), anxiety disorders only (n = 21), or mixed MDE/anxiety disorders (n = 28) were significantly higher, suggesting more severe AED‐related AEs. Univariate analyses revealed that having persistent seizures in the last 6 months and taking antidepressants was associated with more severe AEs. Post hoc analyses, however, showed that these differences were accounted for by the presence of a depressive and/or anxiety disorders. Significance: Depressive and anxiety disorders worsen AED‐related AEs even when presenting as a subsyndromic type. These data suggest that the presence of psychiatric comorbidities must be considered in their interpretation, both in clinical practice and AED drug trials.     

Anxiety disorders,subsyndromic depressive episodes,and major depressive episodes: Do they differ on their impact on the quality of life of patients with epilepsy?

Aims of the study: To compare the impact of anxiety disorders, major depressive episodes (MDEs), and subsyndromic depressive episodes (SSDEs) on the quality of life of patients with epilepsy (PWEs), and to identify the variables predictive of poor quality of life. Methods: A psychiatric diagnosis according to DSM‐IV‐TR criteria was established in 188 consecutive PWEs with the MINI International Neuropsychiatric Interview. Patients also completed the Beck Depression Inventory‐II (BDI‐II), the Centers for Epidemiologic Studies‐Depression (CES‐D), and the Quality of Life in Epilepsy‐89 (QOLIE‐89). A diagnosis of SSDE was made in any patient with total scores of the BDI‐II >12 or CES‐D >16 in the absence of any DSM‐IV diagnosis of mood disorder according to the MINI. Results: Patients with SSDEs (n = 26) had a worse quality of life than asymptomatic patients (n = 103). This finding was also observed among patients with MDEs only (n = 10), anxiety disorders only (n = 21), or mixed MDEs/anxiety disorders (n = 28). Furthermore, having mixed SSDEs/anxiety disorders yielded a worse quality of life than having only SSDEs. Independent predictors of poor quality of life included having a psychiatric disorder and persistent epileptic seizures in the last 6 months. Conclusions: Although isolated mood and anxiety disorders, including SSDE, have a comparable negative impact on the quality of life of PWEs; the comorbid occurrence of mood and anxiety disorders yields a worse impact. In addition, seizure freedom in the previous 6 months predicts a better quality of life.     

Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States

Estimates of 12‐month and lifetime prevalence and of lifetime morbid risk (LMR) of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM‐IV‐TR) anxiety and mood disorders are presented based on US epidemiological surveys among people aged 13+. The presentation is designed for use in the upcoming DSM‐5 manual to provide more coherent estimates than would otherwise be available. Prevalence estimates are presented for the age groups proposed by DSM‐5 workgroups as the most useful to consider for policy planning purposes. The LMR/12‐month prevalence estimates ranked by frequency are as follows: major depressive episode: 29.9%/8.6%; specific phobia: 18.4/12.1%; social phobia: 13.0/7.4%; post‐traumatic stress disorder: 10.1/3.7%; generalized anxiety disorder: 9.0/2.0%; separation anxiety disorder: 8.7/1.2%; panic disorder: 6.8%/2.4%; bipolar disorder: 4.1/1.8%; agoraphobia: 3.7/1.7%; obsessive‐compulsive disorder: 2.7/1.2. Four broad patterns of results are most noteworthy: first, that the most common (lifetime prevalence/morbid risk) lifetime anxiety‐mood disorders in the United States are major depression (16.6/29.9%), specific phobia (15.6/18.4%), and social phobia (10.7/13.0%) and the least common are agoraphobia (2.5/3.7%) and obsessive‐compulsive disorder (2.3/2.7%); second, that the anxiety‐mood disorders with the earlier median ages‐of‐onset are phobias and separation anxiety disorder (ages 15–17) and those with the latest are panic disorder, major depression, and generalized anxiety disorder (ages 23–30); third, that LMR is considerably higher than lifetime prevalence for most anxiety‐mood disorders, although the magnitude of this difference is much higher for disorders with later than earlier ages‐of‐onset; and fourth, that the ratio of 12‐month to lifetime prevalence, roughly characterizing persistence, varies meaningfully in ways consistent with independent evidence about differential persistence of these disorders. Copyright © 2012 John Wiley & Sons, Ltd.     

三种诊断标准对精神分裂症和心境障碍的诊断比较

为了解国内的精神疾病诊断标准与国际标准间的异同，使用美国精神障碍诊断与统计手册第３版修订本定式临床检查提纲（ＳＣＩＤ－Ｐ），作为国际疾病分类第１０版（ＩＣＤ－１０）、中国精神疾病分类方案与诊断标准第２版修订本（ＣＣＭＤ－２－Ｒ）和美国精神障碍诊断与统计手册第４版（ＤＳＭ－ＩＶ）的症状评定工具，对临床初步诊断为精神分裂症的１１４例患者及心境障碍的８２例患者进行上述３种诊断系统间的诊断比较。结果表明：３种标准对精神分裂症的诊断一致性差（Ｐ＜０．０５），差异原因与各标准病程规定不同有关；两两标准间的诊断一致性好。３种诊断标准对心境障碍的诊断一致性较好（Ｐ＞０．０５）；两两标准间的诊断一致性亦好。以ＩＣＤ－１０作为“金标准”，用ＣＣＭＤ－２－Ｒ及ＤＳＭ－ＩＶ诊断两种疾病均具有较好的敏感性和特异性；ＣＣＭＤ－２－Ｒ诊断精神分裂症和ＤＳＭ－ＩＶ诊断心境障碍更加准确。另外，本研究还显示ＳＣＩＤ－Ｐ及３种诊断标准具有较高的信度。提示ＣＣＭＤ－２－Ｒ，ＤＳＭ－ＩＶ均已向ＩＣＤ－１０靠拢。     

Frequency and clinical correlates of adult separation anxiety in a sample of 508 outpatients with mood and anxiety disorders

Pini S, Abelli M, Shear KM, Cardini A, Lari L, Gesi C, Muti M, Calugi S, Galderisi S, Troisi A, Bertolino A, Cassano GB. Frequency and clinical correlates of adult separation anxiety in a sample of 508 outpatients with mood and anxiety disorders. Objective: To evaluate the frequency and clinical correlates of adult separation anxiety disorder in a large cohort of patients with mood and anxiety disorders. Method: Overall, 508 outpatients with anxiety and mood disorders were assessed by the structured clinical interview for diagnostic and statistical manual (IV edition) axis I disorders for principal diagnosis and comorbidity and by other appropriate instruments for separation anxiety into adulthood or childhood. Results: Overall, 105 subjects (20.7%) were assessed as having adult separation anxiety disorder without a history of childhood separation anxiety and 110 (21.7%) had adult separation anxiety disorder with a history of childhood separation anxiety. Adult separation anxiety was associated with severe role impairment in work and social relationships after controlling for potential confounding effect of anxiety comorbidity. Conclusion: Adult separation anxiety disorder is likely to be much more common in adults than previously recognized. Research is needed to better understand the relationships of this condition with other co‐occurring affective disorders.     

Clinical predictors of severe behavioural problems in people with intellectual disabilities referred to a specialist mental health service

Associations between demographic and clinical variables and severe behavioural problems in people with intellectual disabilities were examined in a cross-sectional survey of 408 adults consecutively referred to a specialist mental health service. Severe behavioural problems were present in 136 (33.3%) of the sample. The demographic and clinical predictors of severe behavioural problems in this sample were identified by logistic regression. Age and gender were not associated with severe behavioural problems. The presence of severe ID independently predicted the presence of severe behavioural problems. Schizophrenia spectrum disorders and personality disorders independently predicted the presence of severe behavioural problems, whereas the presence of an anxiety disorder independently predicted their absence. There is an increasing evidence base of relationships between mental disorders and behavioural problems in people with ID although the pattern of these relationships remains unclear.     

Diagnostic validity across racial and ethnic groups in the assessment of adolescent DSM‐IV disorders

We examine differential validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) diagnoses assessed by the fully‐structured Composite International Diagnostic Interview Version 3.0 (CIDI) among Latino, non‐Latino Black, and non‐Latino White adolescents in comparison to gold standard diagnoses derived from the Schedule for Affective Disorders and Schizophrenia for School‐age Children (K‐SADS). Results are based on the National Comorbidity Survey Replication Adolescent Supplement, a national US survey of adolescent mental health. Clinicians re‐interviewed 347 adolescent/parent dyads with the K‐SADS. Sensitivity and/or specificity of CIDI diagnoses varied significantly by ethnicity/race for four of ten disorders. Modifications to algorithms sometimes reduced bias in prevalence estimates, but at the cost of reducing individual‐level concordance. These findings document the importance of assessing fully‐structured diagnostic instruments for differential accuracy in ethnic/racial subgroups. Copyright © 2012 John Wiley & Sons, Ltd.     

The prevalence and incidence of mental ill-health in adults with Down syndrome

Background While there is considerable literature on adults with Down syndrome who have dementia, there is little published on the epidemiology of other types of mental ill‐health in this population. Method Longitudinal cohort study of adults with Down syndrome who received detailed psychiatric assessment (n = 186 at the first time point; n = 134 at the second time point, 2 years later). Results The prevalence of Down syndrome for the 16 years and over population was 5.9 per 10 000 general population. Point prevalence of mental ill‐health of any type, excluding specific phobias, was 23.7% by clinical, 19.9% by Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC‐LD), 11.3% by ICD‐10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (DCR‐ICD‐10) and 10.8% by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Revised (DSM‐IV‐TR) criteria. Two‐year incidence of mental ill‐health of any type was 14.9% by clinical and DC‐LD, 9.0% by DCR‐ICD‐10 and 3.7% by DSM‐IV‐TR criteria. The highest incidence was for depressive episode (5.2%) and dementia/delirium (5.2%). Compared with persons with intellectual disabilities (ID) of all causes, the standardized rate for prevalence of mental ill‐health was 0.6 (0.4–0.8), or 0.4 (0.3–0.6) if organic disorders are excluded, and the standardized incidence ratio for mental ill‐health was 0.9 (0.6–1.4), or 0.7 (0.4–1.2) if organic disorders are excluded. Urinary incontinence was independently associated with mental ill‐health, whereas other personal factors, lifestyle and supports, and other types of health needs and disabilities were not. Conclusions Mental ill‐health is less prevalent in adults with Down syndrome than for other adults with ID. The pattern of associated factors differs from that is found for other adults with ID, with few associations found. This suggests that the protection against mental ill‐health is biologically determined in this population, or that there are other factors protective for mental ill‐health yet to be identified for the population with Down syndrome.     

Maternal anxiety predicts favourable treatment outcomes in anxiety-disordered adolescents

Objective: To determine the differential impact of maternal and paternal internalizing psychopathology on cognitive‐behavioural treatment (CBT) outcome of anxiety‐disordered children and adolescents. Method: Participants consisted of 127 children and 51 adolescents with a primary anxiety diagnosis. Children were randomly assigned to a standardized group CBT or individual CBT; adolescents received individual CBT. Parents received four training sessions. Participants were evaluated at pre‐ and post‐treatment with a clinical interview and with self‐ and parent‐reported questionnaires. Lifetime anxiety and mood disorders in parents were obtained with a clinical interview. Results: For children, no associations were found between maternal and paternal anxiety or mood disorders and treatment outcome. For adolescents, however, maternal lifetime anxiety disorders were positively associated with pre‐post‐treatment improvement in clinician severity ratings and with treatment success. Conclusion: Lifetime maternal anxiety disorders were significantly associated with favourable treatment outcomes in adolescents. Paternal disorders were not associated with treatment response.